巨大儿的产前预测及分娩方式的选择

目的通过对156例巨大儿（体重≥4000g）的临床分析,探讨巨大儿的产前预测及分娩方式,减少母儿并发症的发生。方法对2004年1月-2006年1月两年间在我院住院分娩156例巨大儿进行研究。选择同期分娩的156例正常体重（2500g≤体重〈4000g）作为对照。两组的孕周、宫高、腹围、超声检查、分娩方式、妊娠合并症及分娩并发症进行回顾性分析。结果巨大儿组的孕周、宫高、腹围均高于对照组,差异有统计学意义（P〈0.01）;妊娠期母体并发子痫前期、妊娠期糖尿病的发病率明显升高,差异有统计学意义（P〈0.01）;剖宫产率较对照组升高,差异有统计学意义（P〈0.05）,其中,巨大儿组中剖宫产亚组较阴道分娩亚组新生儿窒息及产伤的发生率明显降低,差异也有统计学意义（P〈0.01）;阴道分娩的软产道裂伤及母体产后出血的发生率明显升高,差异有统计学意义（P〈0.01）。结论产妇分娩的孕周,分娩时宫高、腹围以及超声检查是产前预测巨大儿的相关因素,巨大儿的母体易发生多种严重并发症,选择剖宫产术终止妊娠可降低母儿并发症。

Antenatal Prediction of Macrosomia and Selection of Delivery Mode

Objective To explore the antenatal prediction of macrosomia and appropriate mode of delivery to reduce maternal and fetal complications. Methods 156 cases of macrosomia （weight ≥4 000g） in our hospital from January 2004 to January 2006 were enrolled in the research, and 156 cases of normal birth weight （2 500 g ≤ weight 〈 4 000 g） in the same period were selected as control. The gestational age, palace high, abdominal circumference, ultrasonic examination, delivery methods, pregnancy complications and delivery complications of the both groups were analyzed retrospectively. Results The gestational age, palace high and abdominal circumference of the macrosomia group were higher than that of the control group, there was a significant difference （P 〈 0.01 ）. The mothers complicated by moderate or severe hypertension and gestational diabetes during pregnancy in the macrosomia group were significantly more than that of control group（ P 〈0. 01 ）. The rate of cesarean section operation was also high compared with the control group （P 〈 0.05 ）. In the macrosomia group, the incidence of neonatal asphyxia and birth trauma in cesarean section subgroup was significantly lower than the subgroup in vaginal delivery, the difference was significantly （ P 〈 0.01 ）, and the incidence of the vaginal delivery laceration of the soft birth canal and the postpartum hemorrhage was signifi- cantly increased（ P 〈 0. 01 ）. Conclusion The gestational age, palace high and abdominal circumference are relevant factors of macrosomia antenatal prediction. Many kinds of serious complications may occur to the gravida with macrosomia, and the cesarean section can reduce maternal and infant complications.